Tobacco dependence is a chronic relapsing condition that usually requires repeat quit attempts from tobacco users and long-term behavioral and pharmacotherapy support to achieve long term abstinence. Unfortunately, most cessation programs are not designed to treat tobacco use as a chronic condition and offer only one-time treatments with a finite period of intervention. Low income smokers face even more challenges in benefiting from this "one-shot" approach, as their relapse rates are typically higher than average, due in part to obstacles related to maintaining behavioral change while working and socializing in environments that are more conducive to tobacco use. Quitlines typically serve a large proportion of low-income smokers and are often the only source of tobacco cessation support available to this population. An intervention that targets low income smokers to re-engage in quitline treatment could have great public health impact by exposing this hard to quit group to additional opportunities to receive customized, evidence-based telephone- based tobacco cessation treatment. Interactive voice response (IVR) systems are capable of proactively contacting individuals and can be programmed to provide targeted motivational and informational messages. The primary aims of this research are to 1) Develop an IVR system that delivers tailored audio messages to increase smokers're-engagement in treatment offered by two state quit lines and 2) Evaluate the feasibility and efficacy of an IVR system as a tool to reengage smokers into quitline treatment measured by number of IVR calls answered, number of smokers who re-engage in treatment and satisfaction with IVR calls. A secondary aim of this research is to obtain preliminary evidence of the efficacy of proactively re-engaging low income smokers into treatment on abstinence as compared to usual care. In the development phase of this proposal, smokers who have used quitline support in a previous quit attempt will be recruited and interviewed by telephone to support the development of tailored messages to encourage re-engagement in treatment among low income smokers. In the second phase, a randomized control trial will be conducted, with a sample of 3,000 smokers who used services from two state quitlines. Participants in the trial will be randomized to either receive usual care (no intervention to increase re-engagement) or the IVR intervention to increase re- engagement in treatment. Re-engagement in quitline treatment and quit rates will be measured at six month follow up. PUBLIC HEALTH RELEVANCE: In this study we will develop and test an Interactive Voice Response (IVR) intervention to increase re-engagement in treatment among low income smokers who had used quitline support in a past quit attempt. Intervention will be developed with input of low income smokers and its feasibility, acceptability and its preliminary efficacy tested in a randomized control trial.